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cardio and pulm > LA cardiac pt 2 > Flashcards

LA cardiac pt 2 Flashcards

1
Q

cardiogenic shock CO, SVR, systolic/diastolic

pcwp

A

decreased CO and increases SVR

systolic

PCWP increased

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2
Q

etio of cardiogenic shock

A

cardiac d/s: MI, myocarditis, valve dysfunction, congenital hrt disease, CM, arrhythmias

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3
Q

avoid what in cardiogenic shock

tx

A

aggressive IV fluid tx.

inotropic support: dobutamine, epi

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4
Q

s/s of cardiogenic shock

A

severe respiratory distress

cool, clammy skin

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5
Q

best LDL lowering drugs

A

statins! bile acid sequestrants

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6
Q

best meds to lower TG

A

fibrates! niacin

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7
Q

best meds to increase HDL

A

Niacin! fibrates

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8
Q

lipid meds for type 2 DM

A

statins, fibrates

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9
Q

common valve for endocarditis

A

mitral>atrial>tricuspid>pulm

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10
Q

organism for endocarditis: nml valves/tx

A

st. aureus

nafcillin or oxacillin plus either ceftriaxone or gentamycin

vanco if needed

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11
Q

organism for endocarditis: abnormal/damaged valves/tx

dental procedures

A

st viridans

?

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12
Q

organism for endocarditis: IV drug users /tx

A

st aureus or MRSA

vanco

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13
Q

organism for endocarditis: prosthetic valves/tx

A

staph epidermis

vanco+genta+rifamin

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14
Q

fungal for endocarditis: tx

A

amphoteracin B 6-8 weeks

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15
Q

great gm + coverage

A

PCN and vanco

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16
Q

great gm- coverage

A

gentamycin and ceftriaxone

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17
Q

immunologic phenomena (4)
for endocarditis

A

osler’s nodes, roth spots, +RF, acute glomeronephritis

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18
Q

vascular and embolic phenomena in endocarditis (4)

A

janeway lesions, septic arterial or pulm emboli, ICH

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19
Q

endocarditis test to order first

more sensitive

A

TTE

TEE

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20
Q

endocarditis prophylaxis and what procedures

A

2 gm amox 30-60 min before procedure or clinda 600 if allergic

dental, respiratory, infected skin

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21
Q

pericarditis 2 most common causes

A

idiopathic and viral(coxsackievirus and echovirus)

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22
Q

pericardial friction rub heard best how

A

end expiration, upright, leaning forward

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23
Q

tx for dressler syndrome

A

aspirin or colchicine

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24
Q

avR shows knuckle sigh

A

pericarditis

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25
Q

electrical alternans

A

pericardial effusion

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26
Q

most common non traumatic cause of tamponade

A

malignancy

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27
Q

pulsus paradoxus

A

> 10 mmHg decrease of systolic BP with inspiration

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28
Q

S/s of tamponade

A

cool extremities, reflex tachycardia, peripheral edema, dyspnea, fatigure, shock

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29
Q

cool extremities, reflex tachycardia, peripheral edema, dyspnea, fatigure, shock

A

S/s of tamponade

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30
Q

tamponade echo

A

pericardial effusion + diastolic collapse of cardiac chambers

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31
Q

square root sign on echo

A

constrictive pericarditis

early diastolic dip followed by a plateau of diastasis.

32
Q

constrictive pericarditis leads to restriction of what

affects which side of heart

A

ventricular diastolic filling

right

33
Q

constrictive pericarditis HF signs

A

right: JVD, kussmaul, increased hepatojugular reflex, N/V, peripheral edema

34
Q

constrictive pericarditis tests

sensitivity

A

CXR

echo (rule of restrictive CM), square root sign

CT/MRI: more sensitive: pericardial thickening

35
Q

pulsus paradoxes

A

drop > 10mmHg of systolic BP with inspiration: pericardial tamponade and constrictive pericarditis

36
Q

electrical alternans seen in what

A

pericardial effusion

37
Q

EKG in acute pericarditis

A

diffuse ST elevations(concave) in precordial leads with PR depressions in same leads, T wave inversions, resolution

avR: ST depression and PR elevation

38
Q

AAA, what size is nml and aneurysmal

A

1.5cm and 3.0 cm

39
Q

AAA most common site

A

infrarenal

40
Q

RF for AAA

A

smoking(main modifiable), age>60, caucasian, male, hyperlipidemia, atherosclerosis, connective tissue d/o, syphillis, HTN

41
Q

AAA protective factors

A

female, DM, non caucasian, moderate alcohol consumption

42
Q

describe aortoenteric fistula with AAA

A

presents as acute GI bleed in pts who underwent prior aortic grafting

43
Q

best test for AAA

A

best initial test: CT with contrast, only do in symptomatic hemodynamically stable pts

abd u/s for asymptomatic pts to monitor progression

44
Q

symptomatic hemodynamically unstable pts AAA

A

focused bedside U/S

45
Q

AAA screening

ages
3-4 cm
4-4.5 cm
>4.5 cm
>5.5 or >0.5 cm

A
  • one time screening via u/s in men 65-75
    3-4 cm: u/s every year
    4-4.5 cm: u/s every 6 months
    >4.5 cm: vascular surgeon referral
    >5.5 or >0.5 cm: immediate surgical repair, even if asymptomatic
46
Q

aortic dissection definition and most common 2 sites

high mortality where

A

tear through the innermost layer of the aorta intima due to cystic medial necrosis

ascending most common near the aortic arch of left subclavian (65%); descending 20%

ascending is high mortality

47
Q

3 types of aortic dissection (Debakey)

A

type 1: originates in ascending aorta propagates to at least the aortic arch and often beyond it distally

type 2: originates in and confined to ascending aorta

type 3: originates in descending aorta and rarely extends proximally but it will extend distally

48
Q

BP and pulse with aortic dissection

A

unequal BPs in each arm, decreased peripheral pulses

49
Q

if aortic dissection is ascending, what new murmur is heard

A

AR

50
Q

aortic dissection imaging

A

CT angiogram most common first line.

CXR will show wide medialstinum: classic.

51
Q

aortic dissection Stanford 2 types

A

A. involves ascending aorta and/or aortic arch, and possible descending aorta (anterior CP)

B: involves descending aorta(distal to the left subclavian artery origin), without involvement of ascending aorta and/or aortic arch

52
Q

describe PAD and ischemic rest pain

A

in advanced disease, most common at night and relieved with foot dependency

53
Q

PAD skin on exam

A

atrophic: atrophy, thin/shiny, hair loss, thickened nails, COOL limbs, areas of necrosis. *lateral malleolar ulcers

NO EDEMA

54
Q

skin: atrophic: atrophy, thin/shiny, hair loss, thickened nails, COOL limbs, areas of necrosis. *lateral malleolar ulcers

NO EDEMA

A

PAD

55
Q

color of limb pale on elevation, dependent rubor

A

PAD

dusky red with dependency

56
Q

dusky red with dependency: limb color

A

PAD

57
Q

PAD dx test

gold standard

A

ankle brachial index most useful screening test.

nml is 1-1.2

positive if ABI< 0.90; 0.50 if severe. rest is <0.4

gold standard is arteriography

58
Q

ABI >1.2

A

calcified vessel, may lead to false reading

59
Q

describe acute arterial occlusion

location

A

vascular emergency, most common is thrombotic occlusion (with preexisting PAD).

most common in superficial femoral artery. (or popliteal)

60
Q

PAD vs PVD

  1. oxygen
  2. shape of wounds
  3. temp of leg
  4. edema
  5. skin color
  6. pain
A

PAD: oxygen problem, round red sores, pale/cold, NO EDEMA, sharp pain

PVD: not oxygen problem, irregular shaped sores, warm leg, EDEMA pooling, yellow/brown, dull pain

61
Q

6 Ps for arterial occlusion

A

pain, pallor, paresthesias(often early), pulselessness, poikothermia, paralysis(late finding associated with worse prognosis).

62
Q

arterial occlusion workup

A

bedside arterial doppler, CT angiography quicker.

63
Q

arterial occlusion tx

A

reperfusion; thromboembolectomy

unfractionated heparin and fluid resuscitation for supportive tx

64
Q

distal extremity ischemia both upper and lower extremities, raynaud’s phenomenon, superficial migratory thrombophlebitis

A

buerger’s disease, thromboangiitis obliterans

small and medium vessel vasculitis

65
Q

buerger’s disease, thromboangiitis obliterans dx testing

A

abnormal allen test

aortography: corkscrew collaterals

bx: segmental vascular inflammation

66
Q

corkscrew collaterals

A

buerger’s disease, thromboangiitis obliteran

67
Q

most common primary cardiac tumor, location

A

atrial myxoma, 80% occur in left atrium

68
Q

“ball valve” obstruction of mitral orifice mimicking mitral stenosis on transesophageal echo

A

atrial myxoma

69
Q

triad of embolic phenomenon, MS like sx, flu like sx

A

atrial myxoma

70
Q

prominent S1, low pitched diastolic murmur

A

atrial myxoma or MS

71
Q

only shock with increased PWCP

A

cardiogenic

72
Q

only shock with increased CO

A

septic

73
Q

2 shocks with increased SVR

A

cardiogenic and hypovolemic

74
Q

only shock with decreased HR

A

neurogenic

75
Q
A

electrical alternans, cardiac tamponade

76
Q
A

3 sign, coarctation

cardio and pulm (22 decks)

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